How to Treat Pancreatitis Acute?


Things to note:
  • Nil per mouth.
  • Nasogastric suction when persistent vomiting or ileus occurs.
  • Parenteral fluid replacement to correct metabolic and electrolyte disturbances.
  • Parenteral nutrition support may be necessary.
  • Drainage of abscess, psuedocyst, if required.

Medical Treatment:
For pain:
  • Morphine, slow IV, 10-15 mg 4-6 hourly as required.
Acute symptomatic hypocalcaemia
  • Calcium gluconate 10%, IV infusion, 10 mL as a bolus over 10 minutes.
    • Follow with 60-120 mL diluted in 1 L sodium chloride 0.9%, administered over 12-24 hours.
    • Monitor serum calcium at least 12 hourly.
If serum magnesium less than 0.5 mmol/L:
ADD
  • Magnesium sulphate, IV infusion, 25-50 mmol in 12-24 hours.
    • 1 mL magnesium sulphate 50% equal to 2 mmol magnesium.
Antimicrobial therapy
The administration of prophylcatic antibiotics to patients with severe necrotising pancreatitis prior to the diagnosis of infection is not recommended. For abscess of the pancreas, etc: Broad spectrum IV antibiotics, e.g:
  • Ampicillin, IV, 1 g 6 hourly.
PLUS
  • Gentamicin, IV, 6 mg/kg once daily.
PLUS
  • Metronidazole, IV , 500 mg 8 hourly.


When to refer:
  • All patients with moderate or severe pancreatitis.

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